Family Interaction Research findings & Program clinical - PDF document

7/07/15 Griffith University Family Interaction Research findings & Program � clinical implications Melanie Zimmer-Gembeck Haley Webb Kellie Swan Overview � History of the Family Interaction Program (FIP) ❖ Current programs ❖ Parent-Child Interaction Therapy ❖ Circle of Security – Parent DVD ❖ PCIT ❖ Research findings ❖ Clinical implications ❖ Circle of Security ❖ Preliminary research findings ❖ Clinical implications ❖ Children with Trauma ❖ The Future of the Family Interaction Program ❖ 1

7/07/15 History of FIP � www.sdrs.info/intervention.php � ❖ 2003: Queensland Government: Future Directions Trial ❖ Established in the Psychology Clinic at Griffith University to provide Parent-Child Interaction Therapy (PCIT) ❖ 2004: Selected to continue as a service and a research program ❖ Continuously funded to provide services to Child Safety families ever since ❖ 2006: Extended service to younger children ❖ Now provide services to a wider age range than previously ❖ In the near future, will extend services to older children and teens ❖ Funding currently in place until 2016 Current Programs � Parent Child Interaction Therapy ❖ In vivo coaching of parents in their interactions with their children ❖ Relationship Enhancement phase: ❖ Building parents’ positive attention & animated engagement for desired child behaviour ❖ Actively ignoring undesirable child behaviour to eliminate unintentional reinforcement ❖ Additional Skills Phase: ❖ Providing clear, assertive, and developmentally appropriate instructions ❖ Practice a compliance procedure (i.e., “2 choices”), that involves providing appropriate consequences to non- compliance ❖ Approx. 17 sessions, conducted weekly, for around 45 mins 2

7/07/15 Current Programs � Circle of Security - Parent DVD program Psychoeducation program that presents (via a DVD) attachment principals to parents ❖ in an easy to understand 8-session program Built-in activities that provide parents with an opportunity to reflect on their ❖ caregiving behaviours 11 sessions, conducted weekly, for around 60 minutes ❖ http://circleofsecurity.net https://vimeo.com/122770192 Parent-Child Interaction Therapy � 3

7/07/15 Parent Child Interaction Therapy � - Some research findings � ❖ PCIT has been found to improve: ❖ Parents’ observed emotional sensitivity to their child*** ❖ Parents’ observed praise, positive attention and engagement (and reduced criticism) ❖ Parents’ reported child behaviour problems and emotional symptoms ❖ Parents’ reported depression and stress ❖ Reduces notifications to child welfare agencies Parent Child Interaction Therapy � - Some research findings � ❖ Treatment drop out ❖ Remains a central problem to parenting programs ❖ Premature dropout from parenting programs typically between 30-50% ❖ More psycho-social barriers faced by families = greater drop out ❖ More intensive the treatment = greater drop out ❖ Motivational Interviewing (MI) ❖ Delivered with the goal of increasing caregivers’ motivation to make changes to parenting behaviours, prior to PCIT ❖ MI was effective at improving caregiver’s reported motivation to make changes…but it did not reduce premature drop out 4

7/07/15 Parent-Child Interaction Therapy � - Some research findings � ❖ PCIT limited to 12 coaching sessions is more effective than unlimited sessions of PCIT (Thomas & Zimmer-Gembeck, 2012) ❖ Caution around adding additional components to an already-effective treatment - does not consistently improve its effectiveness ❖ For interventions designed to enhance parent-child relationship during early childhood, meta-analysis revealed: ❖ Shorter, more focused interventions are more effective (Bakermans-Kranenburg et al., 2003) Parent-Child Interaction Therapy � - Clinical applications � ❖ Targeted focus – parenting ❖ Weekly feedback on progress ❖ First 5 minutes of session parent practices their skills independently – results fed back to the parent immediately ❖ Indication of whether practice has occurred between sessions ❖ Provides extra incentive for parents to practice ❖ Systematic feedback improves outcomes (Duncan et al., 2010) 5

7/07/15 Parent-Child Interaction Therapy � - Clinical applications � ❖ Relationship enhancement + positive attention ❖ Remove attention from misbehaviour allows it to extinguish ❖ Stay calm, stop talking, neutral expression ❖ Provide clear and brief instructions ❖ Provide consistent and appropriate consequences immediately, and for today only ❖ Stay calm, and avoid lecturing, threatening, or reasoning Circle of Security - parent DVD � - Some findings � ❖ Anecdotally ❖ High engagement ❖ Often completely new concepts for parents ❖ Applicable to relationships across the life span ❖ Empirically (preliminary findings, N = 29) ❖ Low treatment drop out so far ( n = 2) ❖ Reductions in parenting stress, and in perceptions of the child as “difficult” in the COS treatment group, but not in the waitlist group 6

7/07/15 Circle of Security - parent DVD � - Clinical applications � ❖ Understanding that all of a child’s emotional needs can be found on the circle ❖ What is my child’s behaviour saying about his/her unmet needs? ❖ Parents: Always be bigger, stronger, wiser and kind ❖ “Being with” children in their difficult emotions rather than pushing children to feel better ❖ Empathising and listening versus reasoning with and problem solving ❖ “Shark Music”: a concept to help parents understand their own discomfort with particular child needs ❖ Parent-child relationship as foundation for children’s coping ❖ Quality time is key Parent-Child Attachment Security � Emotional tie between child and caregiver that provides security in times of ❖ threat or challenge Serves as physical and psychological protection ❖ 1. Confidence in the caregiver's availability is thought to enhance the child's ability to explore in novel or challenging situations ❖ SECURE BASE FUNCTION 2. Serves a major protective and coping function when faced with danger ❖ SAFE HAVEN FUNCTION 7

7/07/15 Parent-Child Attachment – Stress, Coping and Psychopathology � Attachment is a “biologically evolved coping strategy for managing fear and distress” (Kobak et al.) Early parent-child relationship experiences are a foundation for development of: ❖ The biological stress and coping system ❖ Sense of self ❖ Ability to manage distress and challenging situations ❖ Beliefs about the self as worthy of support from others ❖ Beliefs about others as trustworthy and reliable Secure parent-child attachment => better ability to regulate intense emotions and cope with stressors (Zimmer-Gembeck et al., in press) Parents’ Emotional Sensitivity � ❖ Emotional sensitivity ❖ A caregiver’s ability to detect, interpret and effectively respond to their child’s cues ❖ Key predictor of parent-child attachment security and many psychosocial outcomes in children ❖ Parental psychopathology => more behavioural and emotional symptoms in their children ❖ Due to some extent to these parents being less able to be sensitive to their children’s needs ❖ Interventions that enhance parents’ sensitivity tend to produce better improvements in parent-child attachment (Bakermans-Kranenburg et al., 2003 – meta analysis) (Zimmer-Gembeck et al., 2013) 8

7/07/15 Parent-Child Interaction Therapy � - Trauma and the Therapeutic Context � Effective across different family circumstances, backgrounds and cultures ❖ Decreases child abuse potential & likelihood of notification ❖ Parents may not have optimal parenting skills ❖ Children may have behaviours that are difficult to ❖ manage Parents’ patience, empathy and warmth may be ❖ reduced PCIT targets parenting skills around the relationship & managing ❖ challenging behaviours Not intended to directly address traumatic experiences ❖ Parent-Child Interaction Therapy � - Trauma and the Therapeutic Context � PCIT may compliment trauma-focused interventions via shared components ❖ Emotion Regulation (describing, reflecting, organising) ❖ Children ❖ Parents/Caregivers ❖ Psycho-education ❖ Child’s Perspective ❖ Consistent, predictable , repetitive, structured 9

7/07/15 Parenting Interventions � - Where to next? � ❖ Treatment drop-out remains a key problem for parenting interventions ❖ Parents’ emotion regulation: ❖ Do parenting interventions assist parents in being sensitive and responsive to their child’s needs, and support their children to tolerate distress by helping parents to better regulate their own discomfort and frustration? ❖ Regulating Overload and Rage (ROAR) 8 – 12 years ❖ Psycho-education, emotion-regulation, and collaborative problem solving (Greene, 2014) ❖ Available from August/September 2015 10